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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 390321278
Report Date: 03/02/2020
Date Signed: 03/02/2020 12:12:23 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:SAN JOAQUIN DELTA COLLEGE CHILD DEVELOPMENT CENTERFACILITY NUMBER:
390321278
ADMINISTRATOR:COOK, NANCYFACILITY TYPE:
850
ADDRESS:5151 PACIFIC AVETELEPHONE:
(209) 954-5702
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY:144CENSUS: 76DATE:
03/02/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Nancy CookTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Gagandeep Singh met with Director, Nancy Cook, for a case management inspection to verify if the facility received the department’s letter informing the facility about the status criminal background clearances of two individuals.

During today’s inspection, director informed LPA that the facility received the letter and send the signed acknowledgement back to the department. Director provided the copy of the signed document to the LPA. Director stated that two individuals were never hired at the facility.

No violation of any regulation was observed. Copy of this report is reviewed and provided to the director. Notice of site visit is posted and shall remain posted for next 30 days.

SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Gagandeep SinghTELEPHONE: (916) 216-7823
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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